Last month a joint letter from the six CLPs effected by the Future Fit Consultation was sent out to Dr Simon Freeman, Accountable Officer, Shropshire Clinical Commissioning Group and David Evans, Chief Officer, Telford and Wrekin CCG with twenty questions highlighting our concerns with the proposals. Just under a month later, we have received a reply. We have split the answers over two posts for better readability. A Press Release shall follow shortly that shall give our feedback on the answers provided.
11 The CCGs’ summary consultation document states that if emergency and planned care are separated, “it would be highly unlikely that planned surgery would be cancelled due to an emergency admission”. Can you also guarantee that bed shortages at the emergency care site will never require transfers to beds at the planned care site and, in consequence, lead to the cancellation of planned care treatments?
Under our proposal, the size of the two hospitals has been modelledto allow for demographic growth, new ways of working and a much lower occupancy level. The lower the occupancy level, the greater the services will be able to respond to increases in demand, especially during the winter. At the Emergency Care site, the ‘front door’ will have more assessment areas for patients to be promptly treated with access to senior decision makers seven days a week. This new way of working will prevent the need for emergency patients to be treated in beds that are needed for planned procedures.
12 Will both hospitals have pathology labs and MRI/CT scanners or in urgent cases will patients and samples have to be transferred between hospitals? If the latter, are the CCGs confident that ambulances or other NHS services will always be available to transport them? What resources have been set aside for such a contingency?
Both hospitals will have diagnostics (including MRI/ CT scanners) and pathology to support the need for urgent tests to be carried out.
13 How much of the £312 million cost of Future Fit will be raised from private finance and what model will be involved; what is the anticipated annual cost of repaying it and over what term?
The £312 million will be made of up a number of different sources but a significant amount will be public capital finance. It is expected that the national and regional NHS organisations involved will be working on the exact breakdown of the funding.
The Shrewsbury and Telford Hospital NHS Trust (SaTH) will pay 3.5% interest on the Department of Health and Social Care public capital. This is standard accounting practice in the NHS and has been included in all our calculations, assuring us on the affordability of both options on which we are consulting. It is expected that SaTH will self-finance a smaller amount over a 10-year period from its annual capital allocation, which is made available to all trusts each year. SaTH is currently exploring alternative funding mechanisms which include support from a Regional Health Infrastructure Company (RHIC). The scheme has yet to be launched by HM Treasury so details are not yet confirmed. Our interpretation of this is that one identifiable aspect of the build will be financed from this route.
14 What NHS land is proposed for sale and what receipt is expected from the sale?
There is currently no NHS land proposed for sale. This would be explored through the STP programme.
15 What is the annual cost of the interest on the £200 million Public Dividend Capital and for what term?
SaTH will pay 3.5% interest on the Department of Health and Social Care public capital. This is standard accounting practice in the NHS and has been included in all our calculations, assuring us on the affordability of both options on which we are consulting.
16 How much of the £312 million will be spent on repairing or converting existing buildings and how much on new buildings?
The £312m is associated with new build and refurbishment. This is currently identified as £222m for new build and £90m for refurbishment of existing facilities across both hospital sites. This will be confirmed as part of the detailed design development process.
17 How many fewer staff, both permanent and temporary and in what categories, will Shropshire’s NHS employ when Future Fit is implemented?
We recognise that, despite SaTH’s best efforts, they continue to have high vacancy levels within their clinical workforce. Their intention is to build a sustainable, high quality clinical team, which includes the introduction of new roles who are substantively employed to help deliver high quality, safe services.
These challenges are one of the key reasons why they need to change the way they deliver care in our two hospitals. We are confident that by having a separate Planned Care and Emergency Care site, it would attract more doctors and nurses to work at both hospitals in the future. There are no plans for any current jobs to be put at risk through these proposals.
18. The CCGs’ consultation materials provide very little detailed information on the Future Fit proposals and how they will be funded and there are no open public meetings at which they can be questioned or debated; how confident are the CCGs that they comply with the Gunning Principles which require that in any consultation the public must “have enough information to make an intelligent choice and input in the process”?
We have organised a series of public exhibition events which are open to everyone to attend. We have, and continue to, work closely with the Consultation Institute who are quality assuring the consultation process. As part of this process, they are offering guidance to make sure we are meeting NHS England’s five tests for reconfiguration and following the Gunning principles. They have provided feedback on all of our consultation documents and our communication and engagement plan in order to make sure local people can receive the information they need to make an informed decision. As part of our commitment to following the Gunning principles, any alternative proposals or suggestions put forward as part of the consultation would, of course, be conscientiously taken into account and carefully considered as part of the process.
19. The CCGs’ consultation questionnaire is not being widely circulated and respondents are not asked to identify themselves which means that false or multiple responses cannot easily be avoided. How can the CCGs be confident that the consultation will genuinely reflect public opinion; how will they analyse the public response and what influence will it have on the final decision?
We have worked closely with the Consultation Institute and consultation specialists, Participate Limited to develop our survey. In accordance with data protection law, our survey does not ask any questions which would enable us to identify anyone. Although not compulsory, our survey does ask people to give the first half of their postcode to enable to us to track the areas where our responses are coming from. It also asks for people to answer a range of questions about themselves to help make sure we are capturing the views of as many different people as possible.
The survey is available online at www.nhsfuturefit.org It is also included in the centre pages of both the main and summary consultation document, which have been widely circulated across Shropshire and Telford & Wrekin. We have made it available at our public events, at meetings we attend such as the Local Joint Committees and through our partners. Please let us know if you require any further copies of the consultation documents by calling 0300 3000 903 or emailing: nhsfuturefit@nhs.net
Once the consultation has closed, all responses will be carefully analysed by consultation specialists, Participate Ltd, who will then produce a report. We will read this report and carefully consider all feedback as part of our decision-making process.
20. Can you provide an assurance that no pressure has been applied by senior management to prevent local NHS staff from expressing their concerns about Future Fit?
We are committed to listening to the views of the staff who work at our hospitals. SaTH has an ongoing staff engagement programme to ensure that every member of staff can have their say. The programme includes weekly roadshows, newsletters and communication through payslips. All staff are free to express their views without fear or favour on the outcome of the consultation, and we have communicated this assurance to all staff at the two CCGs and at SaTH.
Many of our staff have worked together to develop the proposed new model of hospital care that is aimed at delivering improved services to the people that they serve. We have and continue to promote the Future Fit consultation to all our staff and would urge everyone to have their say as everybody’s views are crucial to us.
We trust this answers your questions. These answers are being included in our Frequently Asked Questions on our website www.nhsfuturefit.org. Here you can also access our consultation documents, videos, background information and online survey. We would appreciate your help in encouraging your communities to take part in the consultation. Please email nhsfuturefit@nhs.net if you would like to be sent any paper copies of the consultation documents.